Internal Mammary Vessels: Rib-Sparing Approach

The internal mammary vascular system has become the de facto preference for recipient vessels in microsurgical breast reconstruction. Harvest of the internal mammary vessels has historically required resection of a segment of the costal cartilage to facilitate exposure for the performance of microsurgical anastomosis. The “rib-sparing” approach to vessel harvest has evolved over the last two decades as a safe and reproducible model of vessel harvest, resulting in reduced patient morbidity and aesthetic chest wall deformity. This chapter will characterize the preoperative assessment, relevant anatomy, and surgical approach of the “rib-sparing” technique in the harvest of the internal mammary vessels.